|
MRI, brain, without contrast70551
|
7 |
$129 |
$292 |
$1,190 |
|
MRI, brain, with and without contrast70553
|
7 |
$214 |
$427 |
$2,349 |
|
MRI, lower spine, without contrast72148
|
7 |
$89 |
$230 |
$1,464 |
|
MRI, knee, without contrast73721
|
7 |
$204 |
$292 |
$560 |
|
X-ray, chest, 2 views71046
|
7 |
$26 |
$93 |
$168 |
|
CT scan, abdomen and pelvis, without contrast74176
|
7 |
$104 |
$292 |
$1,278 |
|
Mammogram, screening, both breasts77067
|
7 |
$81 |
$97 |
$279 |
|
X-ray, facial bones70150
|
7 |
$38 |
$124 |
$236 |
|
X-ray, nasal bones70160
|
7 |
$18 |
$81 |
$155 |
|
X-ray, sinuses70220
|
7 |
$15 |
$81 |
$216 |
|
X-ray, skull, limited70250
|
7 |
$19 |
$109 |
$182 |
|
X-ray, soft tissues of the neck70360
|
7 |
$14 |
$81 |
$103 |
|
CT scan, head, without contrast70450
|
7 |
$85 |
$128 |
$1,015 |
|
CT scan, head, with contrast70460
|
7 |
$97 |
$215 |
$363 |
|
CT scan, head, with and without contrast70470
|
7 |
$116 |
$179 |
$1,144 |
|
CT scan, eye socket and inner ear, without contrast70480
|
7 |
$100 |
$128 |
$325 |
|
CT scan, eye socket and inner ear, with contrast70481
|
7 |
$113 |
$179 |
$745 |
|
CT scan, face and jaw, without contrast70486
|
7 |
$89 |
$128 |
$611 |
|
CT scan, face and jaw, with contrast70487
|
7 |
$100 |
$215 |
$801 |
|
CT scan, soft tissues of the neck, without contrast70490
|
7 |
$91 |
$109 |
$316 |
|
CT scan, soft tissues of the neck, with contrast70491
|
7 |
$121 |
$215 |
$764 |
|
CT angiogram, head70496
|
7 |
$70 |
$196 |
$1,184 |
|
CT angiogram, neck70498
|
7 |
$64 |
$196 |
$286 |
|
MRI, eye socket, face and neck, with and without contrast70543
|
7 |
$241 |
$368 |
$747 |
|
MR angiogram, head, without contrast70544
|
7 |
$161 |
$292 |
$1,009 |
|
MR angiogram, neck, without contrast70547
|
7 |
$142 |
$230 |
$582 |
|
MR angiogram, neck, with and without contrast70549
|
7 |
$263 |
$368 |
$997 |
|
MRI, brain, with contrast70552
|
7 |
$189 |
$368 |
$749 |
|
X-ray, chest, 1 view71045
|
7 |
$20 |
$81 |
$133 |
|
X-ray, chest, 4 or more views71048
|
7 |
$24 |
$109 |
$190 |
|
X-ray, ribs, one side71100
|
7 |
$17 |
$81 |
$155 |
|
X-ray, ribs one side, with chest71101
|
7 |
$42 |
$109 |
$128 |
|
X-ray, ribs both sides, with chest71111
|
7 |
$28 |
$109 |
$128 |
|
CT scan, chest, without contrast71250
|
7 |
$55 |
$109 |
$794 |
|
CT scan, chest, with contrast71260
|
7 |
$114 |
$215 |
$1,255 |
|
CT scan, chest, with and without contrast71270
|
7 |
$102 |
$179 |
$1,035 |
|
CT scan, chest, low-dose lung cancer screening71271
|
7 |
$62 |
$97 |
$669 |
|
CT angiogram, chest71275
|
7 |
$179 |
$215 |
$1,933 |
|
X-ray, spine, single view72020
|
7 |
$13 |
$81 |
$94 |
|
X-ray, neck spine, 2-3 views72040
|
7 |
$32 |
$81 |
$188 |
|
X-ray, neck spine, 4-5 views72050
|
7 |
$44 |
$128 |
$332 |
|
X-ray, lower back spine, 2-3 views72100
|
7 |
$32 |
$128 |
$174 |
|
X-ray, lower back spine, 4 or more views72110
|
7 |
$43 |
$128 |
$304 |
|
CT scan, neck spine, without contrast72125
|
7 |
$85 |
$128 |
$1,260 |
|
CT scan, mid-back spine, without contrast72128
|
7 |
$85 |
$128 |
$816 |
|
CT scan, lower back spine, without contrast72131
|
7 |
$84 |
$128 |
$840 |
|
CT scan, lower back spine, with contrast72132
|
7 |
$79 |
$368 |
$688 |
|
MRI, neck spine, without contrast72141
|
7 |
$124 |
$230 |
$1,456 |
|
MRI, mid-back spine, without contrast72146
|
7 |
$123 |
$292 |
$1,436 |
|
MRI, neck spine, with and without contrast72156
|
7 |
$215 |
$427 |
$1,168 |
|
MRI, mid-back spine, with and without contrast72157
|
7 |
$215 |
$427 |
$1,202 |
|
MRI, lower back spine, with and without contrast72158
|
7 |
$215 |
$368 |
$830 |
|
X-ray, pelvis72170
|
7 |
$22 |
$109 |
$194 |
|
CT scan, pelvis, without contrast72192
|
7 |
$76 |
$109 |
$1,042 |
|
CT scan, pelvis, with contrast72193
|
7 |
$174 |
$215 |
$723 |
|
MRI, pelvis, without contrast72195
|
7 |
$162 |
$292 |
$1,156 |
|
MRI, pelvis, with and without contrast72197
|
7 |
$235 |
$411 |
$824 |
|
X-ray, tailbone72220
|
7 |
$18 |
$81 |
$107 |
|
X-ray, collarbone73000
|
7 |
$44 |
$102 |
$161 |
|
X-ray, shoulder, 1 view73020
|
7 |
$10 |
$81 |
$100 |
|
X-ray, shoulder, 2 or more views73030
|
7 |
$81 |
$107 |
$290 |
|
X-ray, upper arm bone73060
|
7 |
$44 |
$107 |
$261 |
|
X-ray, elbow, 2 views73070
|
7 |
$31 |
$107 |
$146 |
|
X-ray, elbow, 3 or more views73080
|
7 |
$30 |
$81 |
$107 |
|
X-ray, forearm73090
|
7 |
$42 |
$81 |
$180 |
|
X-ray, wrist, 2 views73100
|
7 |
$47 |
$103 |
$141 |
|
X-ray, wrist, 3 or more views73110
|
7 |
$72 |
$107 |
$215 |
|
X-ray, hand, 2 views73120
|
7 |
$83 |
$109 |
$163 |
|
X-ray, hand, 3 or more views73130
|
7 |
$81 |
$107 |
$138 |
|
X-ray, finger73140
|
7 |
$42 |
$85 |
$89 |
|
CT scan, arm, without contrast73200
|
7 |
$109 |
$128 |
$817 |
|
CT scan, arm, with contrast73201
|
7 |
$160 |
$427 |
$817 |
|
MRI, arm, without contrast73218
|
7 |
$230 |
$292 |
$740 |
|
MRI, joint of the arm, without contrast73221
|
7 |
$191 |
$292 |
$1,373 |
|
MRI, joint of the arm, with contrast73222
|
7 |
$292 |
$722 |
$1,317 |
|
X-ray, hip, one side, 1 view73501
|
7 |
$6 |
$81 |
$93 |
|
X-ray, hip, one side, 2-3 views73502
|
7 |
$49 |
$93 |
$231 |
|
X-ray, thigh bone, 2 or more views73552
|
7 |
$34 |
$93 |
$153 |
|
X-ray, knee, 1-2 views73560
|
7 |
$14 |
$107 |
$223 |
|
X-ray, knee, 3 views73562
|
7 |
$45 |
$107 |
$287 |
|
X-ray, lower leg73590
|
7 |
$81 |
$107 |
$201 |
|
X-ray, ankle, 3 or more views73610
|
7 |
$81 |
$107 |
$192 |
|
X-ray, foot, 2 views73620
|
7 |
$51 |
$103 |
$127 |
|
X-ray, foot, 3 or more views73630
|
7 |
$81 |
$103 |
$127 |
|
X-ray, heel73650
|
7 |
$32 |
$87 |
$132 |
|
X-ray, toe73660
|
7 |
$32 |
$81 |
$135 |
|
CT scan, leg, without contrast73700
|
7 |
$104 |
$128 |
$818 |
|
CT scan, leg, with contrast73701
|
7 |
$154 |
$208 |
$852 |
|
CT angiogram, leg73706
|
7 |
$179 |
$215 |
$528 |
|
MRI, leg, without contrast73718
|
7 |
$207 |
$255 |
$1,125 |
|
X-ray, abdomen, 1 view74018
|
7 |
$15 |
$81 |
$100 |
|
X-ray, abdomen, 2 views74019
|
7 |
$6 |
$109 |
$127 |
|
CT scan, abdomen, without contrast74150
|
7 |
$82 |
$128 |
$927 |
|
CT scan, abdomen, with contrast74160
|
7 |
$173 |
$197 |
$1,165 |
|
CT scan, abdomen, with and without contrast74170
|
7 |
$179 |
$215 |
$1,343 |
|
CT angiogram, abdomen and pelvis74174
|
7 |
$111 |
$368 |
$2,016 |
|
CT scan, abdomen and pelvis, with contrast74177
|
7 |
$219 |
$427 |
$2,164 |
|
CT scan, abdomen and pelvis, with and without contrast74178
|
7 |
$248 |
$427 |
$1,355 |
|
MRI, abdomen, without contrast74181
|
7 |
$129 |
$269 |
$379 |
|
MRI, abdomen, with and without contrast74183
|
7 |
$202 |
$368 |
$2,465 |
|
Swallowing study, video X-ray74230
|
7 |
$85 |
$179 |
$215 |
|
Upper GI series with air contrast74246
|
7 |
$108 |
$215 |
$378 |
|
Small bowel X-ray series74250
|
7 |
$69 |
$179 |
$243 |
|
Ultrasound, soft tissues of the head and neck76536
|
7 |
$101 |
$128 |
$460 |
|
Ultrasound, chest76604
|
7 |
$87 |
$128 |
$206 |
|
Ultrasound, breast, limited76642
|
7 |
$83 |
$93 |
$371 |
|
Ultrasound, abdomen, complete76700
|
7 |
$103 |
$128 |
$561 |
|
Ultrasound, abdomen, limited76705
|
7 |
$101 |
$128 |
$210 |
|
Ultrasound, kidneys and back of the abdomen, complete76770
|
7 |
$67 |
$128 |
$214 |
|
Ultrasound, kidneys and back of the abdomen, limited76775
|
7 |
$28 |
$128 |
$290 |
|
Pregnancy ultrasound, before 14 weeks76801
|
7 |
$49 |
$101 |
$153 |
|
Pregnancy ultrasound, limited76815
|
7 |
$19 |
$101 |
$239 |
|
Pregnancy ultrasound, transvaginal76817
|
7 |
$15 |
$128 |
$346 |
|
Transvaginal ultrasound76830
|
7 |
$32 |
$126 |
$153 |
|
Pelvic ultrasound, complete76856
|
7 |
$44 |
$128 |
$416 |
|
Pelvic ultrasound, limited76857
|
7 |
$100 |
$128 |
$153 |
|
Ultrasound, scrotum76870
|
7 |
$101 |
$128 |
$156 |
|
Ultrasound, joint or limb, limited76882
|
7 |
$96 |
$101 |
$208 |
|
Ultrasound, infant hips76885
|
7 |
$28 |
$107 |
$129 |
|
Diagnostic mammogram, one breast77065
|
7 |
$79 |
$91 |
$318 |
|
Diagnostic mammogram, both breasts77066
|
7 |
$99 |
$117 |
$308 |
|
Bone age X-ray77072
|
7 |
$12 |
$96 |
$109 |
|
Whole-body bone survey X-ray77075
|
7 |
$44 |
$109 |
$130 |
|
Nuclear stress test, heart blood flow78452
|
7 |
$398 |
$1,252 |
$3,041 |
|
X-ray, chest, 3 views71047
|
6 |
$17 |
$81 |
$93 |
|
X-ray, mid-back spine, 2 views72070
|
6 |
$26 |
$128 |
$138 |
|
X-ray, mid-back spine, 3 views72072
|
6 |
$31 |
$128 |
$200 |
|
X-ray, entire spine, 2-3 views72082
|
6 |
$58 |
$109 |
$112 |
|
X-ray, lower back spine, bending views72120
|
6 |
$29 |
$109 |
$128 |
|
X-ray, sacroiliac joints72202
|
6 |
$31 |
$128 |
$177 |
|
X-ray, both hips, 2 views73521
|
6 |
$33 |
$112 |
$113 |
|
X-ray, knee, 4 or more views73564
|
6 |
$20 |
$109 |
$128 |
|
X-ray, ankle, 2 views73600
|
6 |
$81 |
$103 |
$125 |
|
X-ray, abdomen, 3 or more views74021
|
6 |
$18 |
$109 |
$112 |
|
Upper GI series (barium swallow)74240
|
6 |
$98 |
$215 |
$457 |
|
Bile duct X-ray during surgery74300
|
6 |
$44 |
$188 |
$272 |
|
Heart CT calcium score75571
|
6 |
$56 |
$81 |
$107 |
|
CT angiogram, heart arteries75574
|
6 |
$182 |
$427 |
$1,063 |
|
X-ray, infant, chest and abdomen76010
|
6 |
$23 |
$81 |
$107 |
|
Ultrasound, brain (through the skull)76506
|
6 |
$22 |
$128 |
$153 |
|
Ultrasound, breast, complete76641
|
6 |
$101 |
$112 |
$388 |
|
Fetal wellbeing scan with non-stress test76818
|
6 |
$46 |
$128 |
$153 |
|
Bone density scan (DEXA), spine and hip77080
|
6 |
$32 |
$128 |
$151 |
|
Bone density scan (DEXA), wrist, heel or finger77081
|
6 |
$23 |
$107 |
$140 |
|
Panoramic dental X-ray70355
|
5 |
$11 |
$81 |
$107 |
|
X-ray, mid and lower back spine, 2 views72080
|
5 |
$28 |
$81 |
$107 |
|
X-ray, entire spine, 1 view72081
|
5 |
$35 |
$81 |
$93 |
|
X-ray, pelvis, 3 or more views72190
|
5 |
$35 |
$109 |
$128 |
|
X-ray, both hips, 3-4 views73522
|
5 |
$41 |
$109 |
$112 |
|
Cardiac MRI, with contrast75561
|
5 |
$248 |
$368 |
$427 |
|
CT scan, heart, with contrast75572
|
5 |
$128 |
$324 |
$427 |
|
Angiogram, artery of one arm or leg75710
|
5 |
$136 |
$2,862 |
$2,905 |
|
Ultrasound guidance for placing an IV line76937
|
5 |
$23 |
$98 |
$415 |
|
Joint survey X-ray, 2 or more joints77077
|
5 |
$29 |
$109 |
$128 |